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‘Policy in place but govt fails in implementation’

Interview Dr Sunil Kumar Joshi

Apr 21, 2015-

Jajarkot is gripped by influenza which has blown into an epidemic proportion. The efforts to contain the disease on the government part so far have been inadequate. The disease continues to wreak havoc in many VDCs of the district. Prof Dr Sunil Kumar Joshi is a senior doctor at Kathmandu Medical College with around 15 years of experience in public health research and education. He believes that a simple set of precautions could have averted the health crisis in Jajarkot. Excerpts:

As an expert how do you evaluate the ongoing epidemic in Jajarkot?

We have good plans and policies in place. The government has developed strategic directives to ensure quick response and effective health services during disease outbreaks. However, like many other policies, it has not been implemented and we are now facing its consequences. Despite knowing that the district is vulnerable, the government failed to take any precaution. The fact that the government took days to respond shows how unprepared we are.

I don’t think swine flu –influenza H1N1-is difficult to contain. We don’t need expert doctors for symptomatic treatment of the disease, junior health staffs such as Heath Assistants or Community Medical Assistants (CMA) can treat the disease in its primary phase. The epidemic resulted mainly because of lack of health education and the government’s delay in intervention. There are female community volunteers, the CMA and HA in health and sub-health posts who can very well be mobilised for creating awareness on health education.

Who is to blame for the delayed response?

As far as i see it, the health sector has become more of a political agenda. Various officials raise the question of increasing the number of free medicines, health workers and health institutes. However, no one makes an effort to ensure that the services reach the people. Had the District Public Health Office in Jajarkot taken simple precautions, the disease would not have been such widespread.

What could have been the simple precaution?

What I have learnt is that diseases usually spread from migrant workers who come from India. We all know that swine flu claimed hundreds of lives in India. Therefore, the government could have established screening facilities in districts such as Jajarkot, from where a high number of workers go to the neighbouring country. This is not the first incident of H1N1 outbreak in the country, therefore the government has no excuse. The government should start thinking of using vaccinations in the most vulnerable areas, if required.

The medical staff does not prefer to work in rural areas such as Jajarkot. Do you see this as a genuine concern?

I agree on this. Having said that, we should not forget that it is the government that has the authority to make sure doctors and health personnel work in the area they are deployed to. It is mandatory for all MBBS graduates who studied under government scholarship to work at least for two years in remote districts. But this has not been implemented. This definitely reflects the weakness of the government.

Could you highlight some short and long term solutions for the ongoing problem?

The problem has grown out of proportion due to the delayed response. Preventive and curative activities should be carried out in a large scale. For that, the government should deploy adequate human resources including doctors backed by other supporting medical staff. There should be proper screening to make sure all who have fallen ill have swine flu. They should be treated accordingly. For a long term solution, there should be a strong plan of action in place, with adequate back up staff. The government should also start Public Private Partnership with medical colleges and hospitals to increase its capacity. If each medical college is assigned with three districts almost all the remote areas will have access to decent health facilities.

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